This document provides an overview of basic principles in gynecologic laparoscopy. It discusses the history and development of laparoscopy starting in the 1930s. The basic prerequisites, anatomy, setup, instruments, patient positioning, trocar placement, and indications for laparoscopy are described. Common laparoscopic procedures like salpingectomy, adhesiolysis, endometriosis treatment, and ovarian drilling for PCOS are outlined. The advantages of laparoscopy like quick recovery and fewer complications are contrasted with potential risks.
17. Trocar Placement for Surgery
A) 12mm optical trocar placed at umbilical level
B) and C) 5mm lateral operative trocars placed 3 fingerbreadths above the symphysis
pubis
18. Peritoneum is inflated with CO2
Needle inserted at the umbilical level (primarily used) OR at Palmer’s point (3cm
below costal margin in midclavicular line)
Pressure should not exceed 14 mmHg- respiratory compromise
26. 1.
Proximal tube division
Isthmus is held upwards and outwards
Isthmus is cauterized
Take care not to cauterized the internal
ovarian A. and ovarian branch of the
uterine A.
Divide tube with scissors
28. 3.
Extraction of the tube
Remove tube through an extraction
bag
Verification of hemostasis
Careful lavage
Removal of equipment
Suture/ Steri-strip laparoscopic
incisions
Caution:
•
Endometriosis
•
Utero-peritoneal fistula
29. Normal left adnxa
Normal left adnxa and Douglas pouch
Positive methyline blue test
Positive methyline blue test
35. Phimosis: delayed
methyline blue spill
Dilatation with
Maryland forceps
Phimosis with
methyline Blue jet
Dr.Sherbiny
Free methyline
blue spill
Phimosis of the fimbrial end: Dilatation with Maryland forceps
41. PCOS: Laparoscopic Drilling
Laparoscopic ovarian drilling with either
diathermy or laser is an effective treatment
for anovulation in women with
clomiphene-resistant PCOS.
RCOG Guidelines : Grade A
58
National Institute of Clinical Excellency
(NICE) 2004
42. Tubal bipolar coagulation
Salpingostom
y
Cutting of the medial
part of the tube
Salpingostom
y
Laparoscopic tubal occlusion & salpingostomy of
Hydrosalpinges prior to IVF to improve pregnancy rate